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Foetal supraventricular tachycardia with hydrops fetalis: a role for direct intraperitoneal amiodarone

Published online by Cambridge University Press:  09 May 2014

Sok-Leng Kang ,
David Howe ,
Matthew Coleman ,
Kevin Roman  and
James Gnanapragasam
Sok-Leng Kang
Affiliation:
Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, United Kingdom
David Howe
Affiliation:
Department of Fetal Medicine and Paediatric Cardiology, Southampton General Hospital, Southampton, Hampshire, United Kingdom
Matthew Coleman
Affiliation:
Department of Fetal Medicine and Paediatric Cardiology, Southampton General Hospital, Southampton, Hampshire, United Kingdom
Kevin Roman
Affiliation:
Department of Fetal Medicine and Paediatric Cardiology, Southampton General Hospital, Southampton, Hampshire, United Kingdom
James Gnanapragasam*
Affiliation:
Department of Fetal Medicine and Paediatric Cardiology, Southampton General Hospital, Southampton, Hampshire, United Kingdom
*
Correspondence to: J. Gnanapragasam, MBBS, FRCPCH, Department of Paediatric Cardiology, Southampton General Hospital, Tremona Road, Southampton, Hampshire SO16 6YD, United Kingdom. Tel: +02380794740; Fax: +02380794256; E-mail: James.Gnanapragasam@uhs.nhs.uk
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Abstract

Introduction: Persistent foetal tachyarrythmias complicated by hydrops fetalis carry a poor prognosis, with foetal death reported in excess of a quarter despite treatment. We present our experience with direct intraperitoneal amiodarone administration in eight hydropic foetuses with resistant supraventricular tachycardia. Methods: Amiodarone was injected slowly into foetal peritoneal cavity under ultrasound guidance. All mothers were loaded with oral amiodarone before the procedure and maintained on it. The procedure was repeated guided by foetal rhythm. Result: All eight cases had severe hydrops with a median foetal heart rate of 255 bpm (range 240–300 bpm), and the median gestational age was 27+1 weeks (range 21–33+3 weeks) at presentation. In six cases, the average time for supraventricular tachycardia to revert to sinus rhythm from the first procedure was 11.5 days. In one case, intravascular injection of amiodarone into the umbilical vein was performed before intraperitoneal injection, which resulted in conversion to sinus rhythm sustained until delivery. In the last case, supraventricular tachycardia and severe hydrops persisted and the baby was delivered 5 days later at 34 weeks’ gestation. Hydrops resolved in five foetuses with a mean resolution time of 28.4 days. The mean gestational age at delivery was 34+5 days and seven of eight cases survived beyond the neonatal period with good postnatal outcomes. Conclusion: Intraperitoneal administration of amiodarone is a relatively simple and effective strategy in refractory supraventricular tachycardia complicated by severe hydrops. The intraperitoneal route assures delivery of the drug to the severely hydropic foetus and enables a bolus dose to be delivered for sustained absorption.

Keywords

Intraperitonealfoetalsupraventricular tachycardia
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 3 , March 2015 , pp. 447 - 453
Copyright
© Cambridge University Press 2014 

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